Reproductive & Gynaecological Health - Q1 2021

Q1/ 2021

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Reproductive & Gynaecological Health

Read more at www.healthawareness.co.uk

“Gynaecological health affects every single woman we know.”

Dr Anita Mitra, BSc MBChB PhD, Aka. The Gynae Geek, Academic Specialty Registrar in Obstetrics and Gynaecology, Clinical Research Fellow

Page 2 © I M AG E P R OV I D E D BY A N ITA M ITR A / TH E GY N A E G E E K

“Women are finding it harder and harder to access contraception that suits them.”

“Access to reliable, unbiased resources is essential for fertility patients.”

“Improving care in endometriosis is overdue – but has its challenges.”

Dame Diana Johnson DBE MP APPG on Sexual and Reproductive Health

Gwenda Burns Chief Executive, Fertility Network UK

Lone Hummelshoj Chief Executive, World Endometriosis Society

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On the cover

Teaching women to be bold about gynae health Gynaecological health affects every single woman we know, so why do we find it so hard to have the conversation?

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hen working in clinic, I take pride in ensuring all patients leave feeling they’ve been heard and that I’ve answered their questions and concerns. Having over 135,000 followers on my social media account, now means I can educate thousands more about symptoms and conditions, empowering them with the knowledge and language to make their problems heard by medical professionals.

Sharing my honest, human side I also like to share what I get up to during my shifts, which many people have commented has made them feel more relaxed about going into hospital, especially during the pandemic. I’m not afraid to show my human side online. I think it’s important that our patients are aware that we are normal people who can be relatable and approachable.

I recently spoke about having terrible period pain during a caesarean section on a night shift. I received an outpouring of messages from other women thanking me for making this ‘ok’ to talk about. Why is it that we find it so hard to say the word period or vagina to each other and out loud?

Most notable was the message I received from a male colleague; “Lots of respect here, this is the right conversation to have.” Unfortunately, many people don’t experience such support from those around them.

©LORDN

How COVID-19 has impacted women’s health The pandemic has negatively impacted many areas of women’s health, but in other ways it’s brought important issues to the forefront and forced through advancements in healthcare.

T WRITTEN BY

Dr Edward Morris President, The Royal College of Obstetricians and Gynaecologists

Early medical abortions at home It became clear at the beginning of the pandemic that one barrier facing women was their access to early medical abortions (EMA). In March 2020, we urged the Government to change the law so that women could access EMA at home. This was approved in England, with Scotland and Wales following suit.

Over 40,000 women have now had an early medical abortion at home and the evidence shows it a safe, more effective – and crucially – a kinder service for women.

At the beginning of the pandemic, 500 women per day were travelling to a clinic, sometimes long distance, to access abortion care. This was putting them at risk of infection and transmission of COVID-19. Since this change in regulation, waiting times for abortion care have fallen and women are able to receive care much earlier in their pregnancy.

Dialogue with healthcare professionals So, what’s missing from the conversations we are having and are we really currently meeting the needs of all women?

Sometimes just asking the question, using the correct language and saying something isn’t right is the first step.

As doctors it is our job to listen and help patients make positive change for permanent gain. And that’s my social media mission – that all women are heard.

Dr Anita Mitra is a Specialist Registrar in Obstetrics and Gynaecology. She is also ‘The Gynae Geek’; creator of an Instagram platform that educates and informs around gynaecological health. She has written a book that promises to be your ‘no-nonsense guide to down there healthcare’.

WRITTEN BY Dr Anita Mitra BSc MBChB PhD aka. The Gynae Geek, Academic Specialty Registrar in Obstetrics and Gynaecology, Clinical Research Fellow

his year has been an incredibly challenging year for the healthcare sector and sadly the ripple effect will have been felt by many women across the UK. Women with painful and debilitating gynaecological conditions such as endometriosis and fibroids will have had their operations delayed. Pregnant women will have faced difficult hospital appointments without a partner by their side, and women seeking fertility treatment will have had to put their lives on hold while they wait for the green light.

One in 10 women ‘put off’ getting a smear test during the pandemic over concerns about going to the doctors.

Cervical cancer screening A recent survey by Jo’s Cervical Cancer Trust found that one in 10 women ‘put off’ getting a smear test during the pandemic over concerns about going to the doctors. This is very concerning when pre-pandemic the rates of screening were at their lowest level in two decades.

We supported calls by the charity to make cervical screening more accessible and welcomed the introduction of HPV self-testing kits as part of the cervical screening programme. In countries where this is already offered, there has been significant success and the screening uptake amongst all women has increased.

Delays to fertility treatment For many women, the COVID-19 pandemic has meant severe delays to accessing fertility tests and treatment.

This has had serious consequences for women who are reaching the age limit of being ineligible for IVF on the NHS. After a campaign by several organisations to ‘Stop the Clock’, the NHS issued guidance urging trusts to extend IVF deadlines.

We don’t know what 2021 will bring, but it’s vital that women’s and girls’ rights remain firmly on the agenda while we hopefully begin a return to normal.

Read more at healthawareness.co.uk

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How a new generation of lasers can help improve women’s health and quality of life The use of lasers to treat pelvic floor problems has become increasingly popular in recent years, thanks to new minimally invasive treatment protocols

M WRITTEN BY

Dr Irena Hreljac Clinical Affairs Manager, Fotona

Paid for by Fotona

any women experience urine leakage and other bothersome symptoms of pelvic floor dysfunction during their lifetime; still, these are rarely talked about.

The pelvic floor is a hammock of muscles and connective tissue extending from the pubic bone to the tailbone. It consists of many structures that work in harmony to provide support to the womb, bladder, colon and their connected structures.

With ageing and deliveries, the pelvic floor support weakens, causing symptoms of vaginal laxity, unwanted urine leakage or pelvic organ prolapse.

Menopause can bring about additional problems, such as vaginal dryness, pain and irritation.

Treatment for pelvic floor problems starts with physiotherapy and exercise to strengthen the pelvic floor muscles.

If these conservative treatments don’t help, surgery is usually recommended.

The power of light and heat Recently, a new treatment has become available – non-invasive vaginal laser therapy. Erbium laser with Fotona SMOOTH® technology is an especially gentle, yet effective treatment option.

It does not injure the gentle vaginal tissue, but works through a patented thermal pulsing method, utilising the body’s own potential to build new collagen and improve the condition of the vaginal mucosa. The end result is functional strengthening and regeneration of pelvic floor support, which is achieved naturally, without surgery or implants.

The technology has been shown to improve urine leakage, vaginal dryness and improve sexual function in more than 60 clinical studies, with high effectiveness and minimal side- effects. One study in particular, titled “Safety of Vaginal Erbium laser: A Review of 113,000 Patients Treated in the Past 8 Years” showed that the

procedures are safe and carry a very low risk profile.

Key benefits of laser treatments Patients prefer laser treatments as a non-invasive option that can delay or even diminish the need for surgery.

Laser treatments can perfectly complement and improve the results of physical therapy.

Of course, although laser therapy can help many patients, it is not appropriate for everyone – correct diagnosis and expert and holistic patient management are the key.

Fotona’s patented Fotona SMOOTH® Er:YAG pulse protocol was a key breakthrough that led to the development of an entirely new class of minimally invasive erbium-based gynaecological procedures, which are among the most popular laser treatments available on the market today.

These newer “SMOOTH” treatments are widely used for treating genitourinary syndrome of menopause (RenovaLase®), stress urinary incontinence (IncontiLase®), vaginal relaxation syndrome or vaginal laxity (IntimaLase®) and pelvic organ prolapse (ProlapLase®).

For more information visit fotona-smooth.com fotona.com/en/#gynecology

NHS adopts blood test for pregnancy condition Pre-eclampsia is being identified in pregnant women via a rapid, quantitative fluorescence immunoassay, being rolled out across the NHS in England.

A INTERVIEW WITH

Dr Louise Webster Clinical Lecturer in Women’s Health

WRITTEN BY: Mark Nicholls

Paid for by Quidel

highly specific blood test, is helping pick up the potentially dangerous condition of pre-eclampsia among pregnant women.

PlGF (placental growth factor) testing is available across the NHS in England to identify the condition, which is thought to relate to the placenta.

High blood pressure, protein in the urine and liver function issues are among the tell-tale signs for a condition that can be confirmed by the routine test.

Consultant Obstetrician Louise Webster says pre-eclampsia can range from being mild to very severe and occur late in pregnancy or in the early stages from gestation week 20.

If not picked up, it can, affect development of the unborn child, lead to stillbirth, or develop into full-blown eclampsia, which can result in seizures.

Dr Webster explains: “Placental growth factor is a molecule produced by the placenta. In healthy placentas, we see it rise across gestation to a peak

of around 32 weeks and then it slowly starts to fall after that.”

Early detection If PlGF is not at the levels doctors expect, they can increase monitoring of the mother and baby, though there is no established way of treating pre-eclampsia other than delivering.

Conversely, a normal PlGF level can reassure doctors and pregnant women that they don’t have pre-eclampsia, reducing the number of times they need to attend the hospital.

If identified around the 37-week mark, doctors can take the decision for the baby to be born ahead of full term.

PlGF testing for pre-eclampsia is becoming a routine part of antenatal care when blood pressure is high or protein is found in the urine. Midwives will also ensure women are aware of symptoms of the condition, which include headaches, visual disturbance, swelling of the hands or face and concerns about baby’s movements Studies have shown that PlGF is

The test reassures women that are at less risk, leaving doctors to focus of those at higher risk of developing pre-eclampsia.

better than other currently used tests at predicting which women have pre-eclampsia. A further trial demonstrated that the PlGF test halved the time it took to diagnose preeclampsia in women and also led to reduced adverse outcomes.

Rapid results Dr Webster’s department at a hospital in London use the Quidel platform for the test, which returns results within 15 minutes and shows if a woman has preeclampsia, or not, or if a higher level of surveillance needs to be instigated.

The test reassures women that are at less risk, leaving doctors to focus of those at higher risk of developing pre-eclampsia.

The PlGF-based test, which has NICE endorsement, is available in hospitals across England and the hope is that it will soon be adopted in Wales, Scotland and Northern Ireland.

For further information, please visit: quidel.com

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GPs and menopause: How advice can differ and why The impact of the media debate around the Women’s Health Initiative (WHI) study in 2002 is still being felt today as women and GPs lack confidence in HRT, despite newer studies confirming its effectiveness.

F INTERVIEW WITH Dr Sarah Gray GP Specialist in Women’s Health

INTERVIEW WITH Dr Paula Briggs Consultant in Sexual & Reproductive Health, Liverpool Womens NHS Foundation Trust

SPREAD WRITTEN BY

Gina Clarke

or Dr Paula Briggs, previously a GP and now a Consultant in Sexual and Reproductive Health in Liverpool, many issues with prescribing menopause care can still be attributed to the WHI study. These attitudes impact on what gets ordered and prescribed in each region.

Challenges in accessing treatment She says, “In our area we’re lucky to have a very forward-thinking Deputy Chief Pharmacist who cares about menopausal options, but I have patients visit from a neighbouring trust who are desperate for information and products that aren’t available just a few miles down the road.”

“This is in part due to the sheer size of the multi-disciplinary teams that prioritise hospital care, if there are no menopause advocates on board then it’s hard to fix the restrictive behaviour in area prescribing committees.”

Dr Sarah Gray, a GP in Cornwall for 30-years with a specialism in women’s health, believes that it was the negative messages stemming from both the WHI and the MWS which were so damaging. They contributed to funding for her specialist menopause clinic being cut.

While attitudes are now beginning to change, Dr Gray already feels that valuable time has been lost and that there have been little updates through the NHS on HRT. She says, “For a long time it seemed as though the

profession was hesitant around HRT as when the messaging surrounding the study came out, it created a negative discussion in the media.

Luckily over the last few years that has started to change. However, there are still significant gaps in some GP’s knowledge. Many recognise this and because of the problems experienced by their patients are thinking ‘I need to know this’ which is why education for both GPs and patients is so important.”

Tackling funding issues But both women believe that the innovation between collaborating colleagues is what will drive the conversation forward on the benefits of menopausal care, such as a reduced risk of osteoporosis.

The problem at the heart of these issues is funding. Dr Gray adds, “The council will pay for a coil fitting for contraception reasons, but not menopause. And if the Clinical Commissioning Group (CCG) says no – then who pays?”

For Dr Briggs, she believes the issue is bigger than a North/South divide, she adds, “There would not necessarily be a menopause expert on the Area Prescribing Committee when a decision is made whether to add a drug to the formulary. Local experience of a drug is required to inform the Committee prior to consideration to add a particular product to the local formulary, making it available for GP’s in the area to prescribe on the NHS.”

How virtual consultations help GPs to better understand menopause While women may feel that they are taking up precious resources, women’s health is still a top concern for clinicians such as GPs.

D INTERVIEW WITH

Dr Jane Davis St Erme Medical

r Jane Davis is a GP and British Menopause Society Specialist. She also fronts Rock My Menopause, a campaign of the Primary Care Women’s Health Forum (PCWHF), a group of 10,000 healthcare professionals with a specialist interest in women’s health.

In her evenings, she currently runs Zoom classes for GPs on understanding menopausal symptoms, which have been very well attended during the pandemic. She says, “I’ve watched menopause care for many years and I’m really enjoying seeing people waking up to see how important it is. Not only are women demanding better care but clinicians are becoming more interested

as a result and requesting more training. Even giving up their evenings during this busy time to learn more.”

Tackling the perfect storm Yet Dr Davis admits that GPs continue to struggle against a backdrop of underfunded care, which has tested the system. She thinks that combined with the pressure on women right now – who are often primary care givers to multiple generations – this could create a perfect storm thanks to both socio-economic concerns and rising health problems.

But there has been one benefit of the pandemic. Dr Davis says, “With the role out of telephone and video consulations, we’re finding that women

are opening up now, more than ever.

Whether that’s because they’re in a home environment or they haven’t battled with the traffic to get to a surgery, actually menopause care can be delivered remotely very easily.”

The Rock My Menopause campaign has made it incredibly simple to highlight key concerns thanks to a downloadable template a patient can fill in before speaking to their GP. She adds, “It’s the job of a GP to figure out what’s going on. Whether it’s those embarrassing hot flushes or you can’t sleep at night – our message is talk to us. And don’t apologise!”

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What’s the most important part of women’s health?

Education The fight for women’s healthcare continues, as both GPs and women themselves clamour for information.

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ith a declining take up of HRT after the flawed WHI study, hormone related products were left to gather dust. Research stalled, companies even discontinued products. Theramex rescued crucial HRT products and fixed supply issues to once again provide GPs with a variety of menopause products.

But this isn’t enough for CEO Robert Stewart, he wants women to know that they have choices as they age, and that their GP will support them.

He says, “I’m so proud of our team not just for getting our HRT products relaunched, but also to keep in focus the huge need for education on women’s health issues.

Ensuring the best outcomes “We know that with patients who are better informed, we can expect better outcomes. This is why we’re working with initiatives to help both GPs and patients better learn about the myriad of conditions a woman can face.”

For Stewart, the challenge is not just getting the message out, but tackling the chronic underfunding challenges which has left menopause care a postcode lottery. Still, he is optimistic. “There’s much more awareness now than a few years ago, but it’s clear there’s more to be done. And we want to help.”

THX_003003 Mar 21

INTERVIEW WITH Robert Stewart CEO, Theramex

Addressing women’s health care needs – specialists on the phone With gaps in the NHS, many practices find themselves short-staffed, but thanks to specialist funding, trials of a GP and gynaecologist-led service are helping to address women’s health issues over the phone.

INTERVIEW WITH Dr Karen Morton Consultant Gynaecologist and Medical Director of Tonsmor Doctors from Dr Morton’s

D

r Karen Morton is a Consultant Obstetrician and Gynaecologist who set up Dr Morton’s medical helpline in 2013. Since December, she has worked with several groups of primary care settings to allow patients to use the helpline as part of Tonsmor Doctors, which allows NHS patients to instantly speak with a specialist in women’s health, for free.

She says, “Over 600 practices don’t

have women’s health GP specialists, we want to improve the model and show that the resource is both valued by the patient – and the practice.”

Dr Morton is currently working with Theramex to help validate this model, who is funding the initial access for each practice. It will allow patients to speak to women’s health GPs and gynaecologists through a dial-in phone number that allows patients as much time as they need to talk through their concerns.

Offering a more efficient quality service Dr Morton explains, “We work with the GP practice so that as soon as a patient comes through on the telephone, I have access to their medical history and that initial discussion takes much less time than a private telephone

appointment, but offers more quality time than an appointment in the surgery.” Dr Morton and her team are able to add their notes to the patient’s records and any prescriptions are sent through as normal.

“It’s a new way of working” she adds.

“Women find it amazing to talk to a gynaecologist on a Saturday morning, and the GP practice is happy because they’re offering expert care to their patients without having to take on additional staff internally.

“As a model, telephone care is both cost-effective for the business, and incredibly valuable for the woman.”

Read more at theramex.com

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Being in control of your own healthcare

Why access to contraception is getting harder Contraception is essential – it allows us as women to plan our lives. But for many, accessing contraception is becoming more difficult.

L

ast September, the All-Party Parliamentary Group on Sexual and Reproductive Health, a cross-party group of MPs and Peers, published a report examining access to contraception in England. We found that women are finding it harder and harder to access contraception that suits them.

There’s no single reason for this.

The fragmentation of sexual and reproductive health services has led to a lack of accountability, with no one holding overall responsibility for ensuring women can access contraception. Services have been squeezed by funding cuts. Plus, the pandemic has lengthened waiting lists.

Accessibility matters because it affects women’s lives; without it, accessing care becomes an obstacle course. Women are often bounced from service to service in search of contraception that suits them.

Abortion rates are at an all-time high.

Although it’s reassuring women can safely access abortion services, the fact they are doing so indicates a serious unmet need for contraception within the general population. I have always stood up in Parliament for a woman’s right to choose, but most women would still prefer not to experience an unplanned pregnancy in the first place.

For Ovarian Cancer Awareness Month this March, it is important to raise awareness of the symptoms you need to know and why self-advocacy is important when it comes to your health.

E WRITTEN BY

Dr Alison Wint GP and Member of Target Ovarian Cancer’s GP Advisory Board, Target Ovarian Cancer

Ovarian cancer symptoms Ovarian cancer can be complex to diagnose, four out of five women cannot name one of the key symptoms – bloating.

Currently there are no effective screening tools for the disease, unlike the cervical or bowel screening programmes, yet an early diagnosis can make a huge difference. Knowing the symptoms and advocating for yourself could save your life.

if you’re worried. You wouldn’t go to a meeting with a lawyer or architect unprepared, so don’t be afraid to do the same here.

Video and voice calls with the GP Since the COVID-19 pandemic, GP appointments are not always face-toface. Even though it can feel awkward to discuss gynaecological issues over the phone or video, there are ways to make it easier: many GPs now have online booking questionnaires, which are helpful preparation.

For the call itself, try to make sure you’re in a quiet, well-lit room (if it’s a video call). Bring some notes on the main symptoms you’re noticing – it can help to clarify your thoughts and make sure you don’t forget anything that’s worrying you.

Whatever happens, if you’re worried about it, don’t be afraid to mention ovarian cancer and any family history of the disease, since it can be hereditary. The more your doctor knows, the faster they can diagnose or rule out ovarian cancer.

The more your doctor knows, the faster they can diagnose or rule out ovarian cancer.

What should I know about ovarian cancer?

Firstly, the main symptoms are persistent bloating, feeling full or difficulty eating, tummy pain, and needing to wee more often or more urgently. If they are new for you and continue for three weeks or more, it’s time to take control. Make a note, try to track them and talk to your doctor

Integrating contraception into NHS services We have recommended to the Government that, as Public Health England is reorganised, its contraceptive responsibilities should be re-integrated into the NHS, so women can easily access contraception alongside other sexual and reproductive healthcare.

There are countless other opportunities to improve access.

Offering contraception within maternity services, for instance, results in high uptake and means that new mums don’t have the additional stress of navigating the system with a babe-in-arms. We have also called for the progestogen-only pill to be made available over the counter in pharmacies, without prescription.

We hope to see these recommendations reflected in the Department of Health’s upcoming Sexual and Reproductive Health Strategy, which will be a landmark moment in deciding the future of contraceptive care.

Women make up 51% of the population, and most of us spend almost half our lifetimes trying to control our fertility.

We should take this opportunity to improve access to contraception and change lives for the better.

©Lordn

WRITTEN BY

Dame Diana Johnson DBE MP APPG for Sexual and Reproductive Health

vidence tells us that if you’re involved in your own healthcare decisions, you’ll not only have a better experience in the health system, but also better outcomes in your own treatment and care. This is especially important when it comes to ovarian cancer.

Read more at healthawareness.co.uk

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Why women struggle to talk about vaginal atrophy Vaginal atrophy is one of the more common of the 34 symptoms of the menopause, however it is unsurprisingly one of the least talked about.

W WRITTEN BY

Meg Matthews Menopause Campaigner and Founder, Megs Menopause

e know that there is an awareness problem with the menopause in general and that women just don’t realise it is coming. Layered into that, their intrinsic way of putting other people first and you get the perfect storm. Then consider symptoms that are very undesirable to have to go through, no wonder they don’t want to discuss it openly.

Vaginal atrophy is also defined as postmenopausal atrophic vaginitis, it usually begins with the thinning of the walls of the vagina, caused by decreased oestrogen levels. In fact, without oestrogen, vaginal tissue thins, dries out and the tissue becomes less elastic, more fragile, and as a consequence, it can be injured more easily. The vagina can tighten and shrink causing the shortening of the vagina canal.

Impact on relationships Women suffering with vaginal atrophy can experience painful sexual intercourse and spotting after sex. This can negatively affect their relationship and enjoyment of intimacy. This in turn can lead to vaginismus, which is where the vagina muscle closes due to stress and makes intercourse impossible.

This could be caused by psychological pain from experiencing vaginal atrophy symptoms. They also have a greater chance of chronic vaginal infections and urinary function problems.

Variety of treatments available Importantly, there are a variety of treatments available to help combat these symptoms, you don’t have to live with it. One option is HRT (hormone replacement therapy) which will partially restore your (low) hormones, there are also topical oestrogen creams which work in a similar way. Alongside

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It’s all about being aware of the menopause, understanding the symptoms and then combating that with treatments that work for you. these, vaginal moisturisers which help with dryness and lubricants which help remove friction and pain from intercourse are a great solution.

There are also new treatments such as laser procedures, that gently stimulate collagen production of the tissue within the vaginal wall.

It’s all about being aware of the menopause, understanding the symptoms and then combating that with treatments that work for you.

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We don’t know what 2021 will bring, but it’s vital that women’s and girls’ rights remain firmly on the agenda while we hopefully begin a return to normal. ~ Dr Edward Morris, President, Royal College of Obstetricians and Gynaecologists